Facilitating computerized interactions with EMRs

ABSTRACT

A method for using a health information exchange system which stores patient record data regarding a multiplicity of patients, to serve a first plurality of EMRs each interacting with an EMR community including a set of at least one EMR, the method comprising: for each individual EMR within the first plurality of EMRs, performing a computerized context interception process using a processor to intercept context from the individual EMR and to identify there within an event whereby a health provider using the individual EMR calls up an individual patient&#39;s record from said individual EMR; and responsive to identification of the event, using a computerized output device for providing patient record data, pertaining to the individual patient, to the health provider.

REFERENCE TO CO-PENDING APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/145,903, filed on Dec. 31, 2013, which is a continuation of U.S.patent application Ser. No. 13/208,417, filed on Aug. 12, 2011, which isa continuation-in-part of U.S. patent application Ser. No. 12/840,806,filed Jul. 21, 2010. U.S. patent application Ser. No. 13/208,417 furtherclaims priority to U.S. Provisional Patent Application No. 61/438,762,filed Feb. 2, 2011. The entireties of each of these applications areincorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates generally to systems for processingmedical information and more particularly to computerized interactionswith EMRs.

BACKGROUND OF THE INVENTION

Conventionally, information is transferred between an HIE and EMR viamessages exchanged between the two systems. For example, an EMR may knowhow to import lab results from an HIES. An EMR may provide a tab in itsmain application, sometimes known as the “community tab” which enables auser to view, but not manipulate or import, HIE-provided informationabout a patient. Varying medical technology between the HIE and EMR,combined with a lack of ability to semantically resolve the variation,may impose limitations to these modes of information transfer.

According to Wikipedia, an Enterprise Master Patient Index (EMPI) is “aform of customer data integration (CDI) specific to the healthcareindustry. Healthcare organizations or groups of them will implement EMPIto identify, match, merge, de-duplicate, and cleanse patient records tocreate a master index that may be used to obtain a complete and singleview of a patient. The EMPI will create a unique identifier for eachpatient and maintain a mapping to the identifiers used in each record'srespective system.” It has been claimed that by using an EMPI for“correctly matching patient records from disparate systems and differentorganizations”, it is possible to obtain “a complete view of a patient”.

Known technologies relevant to the field of the invention includecontext management, single sign-on, CCOW or Screen capturing method forcontext interception.

Other state of the art health information exchange and integrationsystems, and conventional technology pertaining to certain embodimentsof the present invention, are described in the following publicationsinter alia:

-   1. US20070118540-   2. US20090125555-   3. US20080189496-   4. WO2007010485-   5. JP6243152-   6. DE10163469-   7. US20040141661-   8. US20090080408-   9. US20040122709-   10. US20040122719-   11. US20040122787-   12. US20040122707-   13. Published US Application US20080046292;-   14. Published US Application US20050144043; and-   15. Published PCT Application WO/2007/084502.    Non-Patent Literature describing health information exchange through    the use of semantic technology includes:-   Comput Methods Programs Biomed., 2009, 93 (3), 297-312-   XML technologies for the Omaha System: a data model, a Java tool and    several case studies supporting home healthcare-   Vittorini Pierpaolo; Tarquinio Antonietta; di Orio Ferdinando-   Digital Society, 2009. ICDS '09. Third International Conference,    168-173-   Semantic Exchange of Medicinal Data: A Way Towards Open Healthcare    Systems-   Puustjarvi, J and Puustjarvi, L-   Engineering in Medicine and Biology Society, 2009. EMBC 2009. Annual    International Conference of the IEEE, 1726-1729-   Interoperability of personal health records-   Lahteenmaki, Jaakko; Leppanen, Juha and Kaijanranta, Hannu-   Information Technology: New Generations, 2009. ITNG '09. Sixth    International Conference; 308-313-   Healthcare Applications Interoperability through Implementation of    HL7 Web Service Basic Profile-   Hussain, M; Afzal, M; Ahmad, H. F; Khalid, N and Ali, A-   Computer-Based Medical Systems, 2009. CBMS 2009. 22nd IEEE    International Symposium; 1-6 Ontology-based approach to achieve    semantic interoperability on exchanging and integrating information    about the patient clinical evolution-   Miyoshi, N, Ferreira, A and Felipe, J. C.-   Computer-Based Medical Systems, 2009. CBMS 2009. 22nd IEEE    International Symposium; 1-6 Semantic biological image management    and analysis-   Chubb, C, Inagaki, Y, Cotman, C, Cummings, B and Sheu, P. C.-   Lähteenmäki, Jaakko, Leppänen, Juha, Kaijanranta, Hannu,    “Interoperability of Personal Health Records” (2009) 31st Annual    Int. Conference of the IEEE Engineering in Medicine and Biology    Society, EMBC'09, Minneapolis, Minn., USA, 2-6 Sep. 2009, EMBC′09    DVD, 1726-1729.-   Miyoshi, N. Ferreira, A. Felipe, J. C., “Ontology-based approach to    achieve semantic interoperability on exchanging and integrating    information about the patient clinical evolution”, Computer-Based    Medical Systems, 2009. CBMS 2009. 22nd IEEE International Symposium    on Issue Date: 2-5 Aug. 2009-   Healthcare Services Specification Project (HSSP) Service Functional    Model (SFM) Specification—Decision Support Service (DSS), Version    1.0, Sep. 27, 2006, available on the World Wide Web.

The disclosures of all publications and patent documents mentioned inthe specification, and of the publications and patent documents citedtherein directly or indirectly, are hereby incorporated by reference.

SUMMARY OF THE INVENTION

Certain embodiments of the present invention seek to provide a technicalsolution for the problem of allowing medical data to be effectivelyretrieved, stored, and presented to medical service providing userswhere the medical data exists in digital form within a plethora ofnon-compatible, partially overlapping software systems which areconstantly being updated.

Certain embodiments of the present invention seek to provide aninteroperability solution for medical databases, providing a healthinformation exchange system typically storing complete, single andharmonized patient records, and easing access thereto by bringingrelevant information to a user at points in time in which thatinformation is useful and as part of her or his workflows.

Certain embodiments of the present invention seek to bring relevantcontext-based information from inside the health information exchangesystem to a user e.g. physician's working environment and workflows(typically EMR), rather having the physician leave his workingenvironment and search for the information he needs in a Clinical Vieweras an external application.

Certain embodiments of the present invention seek to enhance effectivesoftware compatibility including reducing dependency on EMR vendors tocustomize their software products in order to integrate with the healthinformation exchange system platform (Button, Smart Access, and otherservices).

Certain embodiments of the present invention seek to provide easy andefficient access to specific context-based patient informationeliminating the need to navigate through many patient's views in anexternal application.

Generally, Health Information Exchange (HIE) is defined as themobilization of healthcare information electronically acrossorganizations within a region, community or hospital system. HIEprovides the capability to electronically move clinical informationamong disparate health care information systems while maintaining themeaning of the information being exchanged. The goal of HIE is tofacilitate access to and retrieval of clinical data to provide safer,more timely, efficient, effective, equitable, patient-centered care. Tomeet this goal, HIE providers develop computerized infrastructures andapplications that enable the information exchange and viewing ofexchanged information. As HIE solutions complement the EMR applications,the EMR and HIE vendors are looking for ways to integrate with eachother in order to enable:

-   -   1. Data exchange from the EMR the HIE and vice versa    -   2. Integrate the information hold in hold in the IHE within the        EMR application and user workflow    -   3. Enrich EMR capabilities with the HIE solutions and services.

When all HIE solution is integrated with the EMR, both accessibility andUser Context may be taken into account.

Certain embodiments of the present invention seek to provide anSOA-based platform that enables healthcare organizations and healthinformation exchanges (HIEs) to integrate their information assets,through the creation of a virtual patient record by logically connectinga group of care providers and organizations without requiring thereplacement of existing information systems. By providing ubiquitousaccess to integrated patient information, the solution virtually bridgesgaps that often exist between inpatient/acute care and community care.

Typically, a single, virtual patient record contains complete andharmonized patient data by logically connecting a group of careproviders and organizations without requiring the replacement ofexisting information systems. Smooth and easy access to thecare-critical information stored in the HIE should be facilitated, byproviding a user with relevant patient information at the point in timeit is needed, as part of the clinical workflow.

The system shown and described herein may perform any or all of theabove functionalities:

-   -   Provide important, relevant, context-based information from the        HIE within a physicians' work environment and workflows        (typically their EMRs)—as opposed to having the physicians leave        their work environments and enter the HIE's Clinical Viewer        functionality as an external application to search for the        information needed.    -   Reduce the HIE's dependency on EMR vendors to customize their        products in order to integrate with the HIE's platform (e.g.        launch button, SSO, services).    -   Provide efficient access to specific context-based patient        information, thereby eliminating the need to navigate through        multiple clinical views in an external application such as a        dbMotion Viewer.        The SmartAgent is a client application that is designed to meet        the EMR users' need to get comprehensive and relevant clinical        information on patients from sources of information which are        not in their EMR, and ill addition to serve as a gateway to HIE        applications and solutions.        The client application, typically installed on the user's        machine, is termed herein a SmartAgent client. Examples of use        scenarios include but are not limited to the following:

-   1. Smart Button within User, Patient and System Context: User opens    a patient record in his EMR. SmartAgent, which is installed in his    client machine, “captures” the patient identifier (MRN), the User    Context (Username/Role) and the System context (SystemID) and calls    a VPO Analyzer web service or Virtual Patient Object Clinical Data    Web Service) that identifies the System, user and the patient. The    user is authorized and the patient is found in the health    information exchange system. The Client SmartAgent gets the response    and presents a Floating Button. The Floating button includes Link to    Launch Viewer with user and patient context. The User presses the    button and seamlessly accesses the health information exchange    system's Clinical Viewer.

-   2. VPO Analyzer attention rules: In order to bring more relevant    information to the user, smart evaluations arc typically provided on    the VPO in the context of the user, patient and system. One of the    Analyzer's attention rules may be “Exclude System Data” which    excludes from the VPO Data that exists in the physician's own    system. The response is “Clean” data excluding what a user can see    in his EMR, which may be presented within the Results or Viewer    Panes. The rule is typically constructed and operative to analyze    the patient's clinical data and to alert the user in the SmartAgent    client application that information that meets the rule exists and    is available for viewing.

-   3. Semantic Search: A user may for example be looking for data on    Diabetes in the health information exchange system. To do that he    enables a search option in the floating toolbar and type the phrase    “Dia”. Search suggestions arc presented and user selects the    “Diabetes” Suggestion. As a result a “Results and Navigation” pane    opens and presents the results for Diabetes from the Patient's VPO    organized by Clinical Aspects (Medications, Problems, Population    Membership, etc.). User presses “Diabetes” population and the    Diabetes View is opened in the View panel.

-   4. Data Presentation and Launch Viewer: Any information found may be    presented in a Data and Navigation Panel. The information is    organized according to the different clinical aspects (Laboratory,    Medications, etc.) and evaluation aspects (Population membership,    Metrics, Notifications, Alerts etc.). The clinical aspects and    actual presented data may constitute a link to a relevant page in    the health information exchange system's Clinical Viewer. The user    can see under a Laboratory Results menu, a result for hbA1c from,    say, a previous week. Aside from the result, 2 buttons may be    provided, one to open the Laboratory Clinical View and another to    open the Lab Result Page with the hbA1c history.

The present invention also typically includes at least the followingembodiments:

-   -   a. A computerized system for supplying a human user with        relevant, context-based patient information within the user's        work environment and workflows.    -   b. A system according to embodiment a wherein the user's work        environment includes at least one EMR.    -   c. A system according to embodiment b which does not require        customization of the EMR.    -   d. A system according to embodiment ‘a’ which supplies        information without requiring the user to navigate through        multiple clinical views in an external application.    -   e. A system according to embodiment ‘a’ wherein the system        includes a proactive apparatus which operates proactively,        responsive to user context operations, to present relevant        clinical information.    -   f. A system according to embodiment ‘a’ wherein the system        includes a processor operative to select relevant information        including performing a computerized analysis of a computerized        patient record and deriving, from the analysis, relevant        clinical information which is presented to the user, whereas        other clinical information is not presented to the user.    -   g. A system according to embodiment ‘f’ wherein differentiation        of relevant clinical information from other clinical information        is based on at least one of the following: user context,        profile, patient illness, ward context, EMR Workflow Context.    -   h. A system according to embodiment ‘a’ and wherein the system        is operative to provide information, within the workflow, on        overall patient events and evaluations for each individual        physician or user.    -   i A system according to embodiment ‘a’ and also comprising at        least some aspects of a skin application shown and described        herein.    -   j. A computerized method for supplying a human user with        relevant, context-based patient information within the user's        work environment and workflows.    -   k. A method according to embodiment ‘j’ wherein the user's work        environment includes at least one EMR.    -   l. A method according to embodiment ‘k’ which does not require        customization of the EMR.    -   m. A method according to embodiment ‘j’ which supplies        information without requiring the user to navigate through        multiple clinical views in an external application.    -   n. A method according to embodiment T wherein the method        includes a proactive apparatus which operates proactively,        responsive to user context operations, to present relevant        clinical information.    -   o. A method according to embodiment ‘j’ wherein the method        includes a processor operative to select relevant information        including performing a computerized analysis of a computerized        patient record and deriving, from the analysis, relevant        clinical information which is presented to the user, whereas        other clinical information is not presented to the user.    -   p. A method according to embodiment ‘o’ wherein differentiation        of relevant clinical information from other clinical information        is based on at least one of the following: user context,        profile, patient illness, ward context, EMR Workflow Context.    -   q. A method according to embodiment ‘a’ and wherein the system        is operative to provide information, within the workflow, on        overall patient events and evaluations for each individual        physician or user.    -   r. A method according to embodiment T and also comprising at        least some aspects of a skin application shown and described        herein.    -   s. A computer program product, comprising a computer usable        medium having a computer readable program code embodied therein,        the computer readable program code adapted to be executed to        implement any of the methods shown and described herein.

Certain embodiments of the present invention seek to provide a decisionmaking system including a system of logic including hierarchicalsemantic relationships, a plurality of systems of medical informationwhich are provided in a plurality of local terminologies respectively,and a decision making apparatus for transforming the medical informationin the local terminologies to transformed information usable by thesystem of logic and for using the system of logic to make at least onedecision based on the transformed information, without translating thesystem of logic into the plurality of local terminologies. The term“terminology” is intended to include any scheme for representing medicalinformation. The following terms and other terms defined herein may beconstrued either in accordance with any definition thereof appearing inthe prior art literature or in accordance with the specification, or asfollows:

-   -   Classification Type—A base set of classifications which all        others derive from. The existing classifications are:        -   Candidate—represents a new population element entering the            system.        -   ActiveMember—represents a member of the population currently            being monitored        -   DormantMember—represents a member who is “sleeping” or            currently active but not being monitored (in a dormant            state)    -   Evaluation Task—an evaluation task combines a set of executable        rules, an evaluation goal, activation, and a set of triggering        rule subscriptions. When a member is associated with a task (by        having a specific classification) the triggering rule        subscriptions are sent to the Data Event Monitor for that        member. When task processing is activated, if that member has        had any matching triggering rules fire, the task is sent to be        processed (along with the member details).    -   Member—The population element of a specific Guard, each member        is tagged with its population source and contains a list of        classifications.    -   Member Classification—Guard evaluation tasks are grouped by        classifications. If a member belongs to a specific        classification, that member has certain tasks associated with        him or her.    -   Population Source—the source of members for the Guard, could be        an external list, an enrollment service, or a data event        monitor.    -   Triggering Rule Subscription—subscription for the Abstract Rule        Monitor, contains a Pattern Rule Identifier and a set of        subscription arguments.    -   Schedule—an alarm (scheduled or event based) used to activate        processing for a particular evaluation task (or set of        evaluation tasks).    -   DEM—data event monitor e.g. as described herein    -   EMPI—Conventional Enterprise Master Patient Index service    -   Principal Index—aka (also termed herein) Leading Index    -   VIA—a commercial Virtual Identity Aggregation service provided        by DBMotion Inc., Israel    -   ACEI—angiotensin-converting enzyme inhibitors    -   LVS—Left Ventricular Systolic    -   LVSD—Left Ventricular Systolic Dysfunction    -   DBMotion—refers to a functionality which is either commercially        available from DBMotion Inc., Israel and/or is shown and        described herein. Other definitions, acronyms, and abbreviations        useful in understanding certain embodiments of the present        invention, are provided in the table of FIG. 2 of incorporated        U.S. patent application publication no. 2012/0215560.

In accordance with an aspect of the invention, there is provided ahealth information exchange system comprising an apparatus for archivinghealth information using a health information encoding procedure only ifthe health information fulfills a criterion of frequent use; and anapparatus for using a first procedure to respond to queries pertainingto the health information which fulfills the criterion of frequent useand using a second procedure to respond to queries not pertaining to thehealth information which fulfills the criterion of frequent use.

In accordance with an aspect of the invention, there is further provideda health information exchange system comprising an ontological apparatusfor defining and storing ontological link elements ontologically linkingbetween individual health care information items within a firstpopulation of health care information items; an apparatus for receivinga second population of health care information items and for associatingat least some individual items in the second population, withcorresponding individual items within the first population of healthcare information items; and an apparatus for responding to queriesregarding particular information items in the second populationincluding translating the particular information items into items in thefirst population corresponding to the particular information items andusing link elements linking the items in the first populationcorresponding to the particular information items to generate datapertaining to the particular information items in the second population.

In accordance with an embodiment of the invention, there is provided asystem comprising an apparatus for making at least one health decisionbased on the queries.

In accordance with an embodiment of the invention, there is furtherprovided a system also comprising apparatus for implementing the atleast one health decision.

In accordance with an embodiment of the invention, there is furtherprovided a system also comprising apparatus for making at least onehealth decision based on the queries.

In accordance with an embodiment of the invention, there is furtherprovided a system also comprising apparatus for implementing the atleast one health decision.

In accordance with an aspect of the invention, there is provided ahealth information exchange method comprising archiving healthinformation using a health information encoding procedure only if thehealth information fulfills a criterion of frequent use; and using afirst procedure to respond to queries pertaining to the healthinformation which fulfills the criterion of frequent use and using asecond procedure to respond to queries not pertaining to the healthinformation which fulfills the criterion of frequent use. In accordancewith an aspect of the invention, there is provided a health informationexchange method comprising defining and storing link elements linkingbetween individual health care information items within a firstpopulation of health care information items; receiving a secondpopulation of health care information items and associating at leastsome individual items in the second population, with correspondingindividual items within the first population of health care informationitems; and responding to queries regarding particular information itemsin the second population including translating the particularinformation items into items in the first population corresponding tothe particular information items and using link elements linking theitems in the first population corresponding to the particularinformation items to generate data pertaining to the particularinformation items in the second population.

In accordance with an embodiment of the invention, there is furtherprovided a method also comprising making at least one health decisionbased on the queries.

In accordance with an embodiment of the invention, there is stillfurther provided a method also comprising implementing the at least onehealth decision.

In accordance with an embodiment of the invention, there is yet furtherprovided a method also comprising making at least one health decisionbased on the queries.

In accordance with an embodiment of the invention, there is yet furtherprovided a method also comprising implementing the at least one healthdecision.

In accordance with an aspect of the invention, there is provided acomputer program product, comprising a computer usable medium having acomputer readable program code embodied therein, the computer readableprogram code adapted to be executed to implement a health informationexchange method comprising archiving health information using a healthinformation encoding procedure only if the health information fulfills acriterion of frequent use; and using a first procedure to respond toqueries pertaining to the health information which fulfills thecriterion of frequent use and using a second procedure to respond toqueries not pertaining to the health information which fulfills thecriterion of frequent use.

In accordance with an aspect of the invention, there is yet furtherprovided a computer program product, comprising a computer usable mediumhaving a computer readable program code embodied therein, the computerreadable program code adapted to be executed to implement a healthinformation exchange method comprising defining and storing linkelements linking between individual health care information items withina first population of health care information items; receiving a secondpopulation of health care information items and for associating at leastsome individual items in the second population, with correspondingindividual items within the first population of health care informationitems; and responding to queries regarding particular information itemsin the second population including translating the particularinformation items into items in the first population corresponding tothe particular information items and using link elements linking theitems in the first population corresponding to the particularinformation items to generate data pertaining to the particularinformation items in the second population.

In accordance with an embodiment of the invention, there is yet furtherprovided a computer program product wherein the method also comprisesmaking at least one health decision based on the queries.

In accordance with an embodiment of the invention, there is yet furtherprovided a computer program product wherein the method also comprisesimplementing the at least one health decision.

In accordance with an embodiment of the invention, there is yet furtherprovided a computer program product wherein the method also comprisesmaking at least one health decision based on the queries.

In accordance with an embodiment of the invention, there is yet furtherprovided a computer program product wherein the method also comprisesimplementing the at least one health decision.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the second population of health careinformation items are expressed in a local terminology and are mapped toa baseline terminology in which the first population of health careinformation items are expressed, to enable terminology interoperabilityat least when responding to queries.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the baseline terminology is semanticallyenriched by associating semantic information therewith, the method alsocomprising generating conclusions about health information expressed inat least one local terminology by using the semantic information ratherthan by defining semantic relations for the local terminology.

In accordance with an embodiment of the invention, there is yet furtherprovided a system in which only a subset of a universe of healthinformation is archived.

In accordance with an embodiment of the invention, there is yet furtherprovided a system wherein the apparatus for responding to queries uses afirst procedure to respond to queries pertaining to the subset and usesa second procedure to respond to queries not pertaining to the universeof health information but not pertaining to the subset.

In accordance with an embodiment of the invention, there is yet furtherprovided a system also including an end user interface allowing endusers to define rules; and a decision support subsystem (DSS)interacting with the end user interface and using semantic capabilitiesof a baseline terminology in which the first population of healthinformation items is encoded, to simplify definition of rules by the endusers.

In accordance with an embodiment of the invention, there is yet furtherprovided a system wherein the decision support subsystem comprises anEnterprise DSS which has a process cycle and which uses DSS rules todefine all phases in the process cycle.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using is applied to ause case involving processing of Smart Guard Adapters, the processingincluding at least one of developing, defining and configuring.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using is applied to ause case involving a SmartWatch System, the use case including at leastone of processing and monitoring health of the system.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using are applied to ause case involving Managing Guard runtime.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using are applied to ause case involving applying Guard changes.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using are applied to ause case involving task activation based upon a schedule.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using is applied to ause case involving identifying patients to be added to a definedpopulation of patients.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the translating and the using are applied to ause case involving monitoring a population of patients includingdetermining if they need to be evaluated, evaluating them thereby togenerate at least one evaluation result, and responding to theevaluation result.

In accordance with an embodiment of the invention, there is yet furtherprovided a method wherein the health information encoding procedureincludes mapping health information expressed in at least one localterminology to a baseline terminology to enable terminologyinteroperability and storing ontological information interrelatinghealth information items expressed in the baseline terminology.

In accordance with an embodiment of the invention, there is yet furtherprovided a system wherein the ontological apparatus includesinterrelationships between clinical-level information items.

In accordance with an embodiment of the invention, there is yet furtherprovided a system wherein the clinical-level information item comprisesat least one health care information item specifying at least one of adisease, rather than only a class thereof, and a medication, rather thanonly a class thereof, such as “Left Ventricular Heart Failure”, ratherthan “Cardio-vascular disorder”, and “Amoxicillin 250 MG Oral Capsule[Amoxymed]”, rather than “Antibiotic”, respectively.

In accordance with an embodiment of the invention, there is yet furtherprovided a system wherein the ontological apparatus maps at least onelegacy concept expressed in local terminology to at least one ontologyconcept expressed in a baseline terminology thereby allowing queries onthe level of a single legacy concept to be responded to, for example,the following legacy concept: (System: ICD9, Code: 428.9, Designation:HEART FAILURE NOS) may be mapped to the following Ontology concept:(System: SNOMED-CT; Code: 84114007; Designation: Heart failure(disorder). Very generic examples of classifications are “Disorder”,“Medicine”, “Procedure”; more specific classification examples are“Cardio-vascular disorder”, “Antibiotics” etc. Classifications do notidentify a patient's clinical status; for example, it is not enough tosay in a clinical record that the patient has “Cardio-vascular disorder”as there are many types of such disorders, and it is typically useful toknow which disorder the patient suffers from, to decide how to treat it.Examples of clinical-level information items are “Left Ventricular HeartFailure”, “Amoxicillin 250 MG Oral Capsule [Amoxymed]”; theseinformation items are sufficiently detailed to describe aspects of anindividual patient's clinical status and/or treatment rather than mereclassifications thereof.

Also provided is a computer program product, comprising a typicallynon-transitory computer usable medium or computer readable storagemedium, typically tangible, having a computer readable program codeembodied therein, said computer readable program code adapted to beexecuted to implement any or all of the methods shown and describedherein. It is appreciated that any or all of the computational stepsshown and described herein may be computer-implemented. The operationsin accordance with the teachings herein may be performed by a computerspecially constructed for the desired purposes or by a general purposecomputer specially configured for the desired purpose by a computerprogram stored in a typically non-transitory computer readable storagemedium.

Any suitable processor, display and input means may be used to process,display e.g. on a computer screen or other computer output device,store, and accept information such as information used by or generatedby any of the methods and apparatus shown and described herein; theabove processor, display and input means including computer programs, inaccordance with some or all of the embodiments of the present invention.Any or all functionalities of the invention shown and described hereinmay be performed by a conventional personal computer processor,workstation or other programmable device or computer or electroniccomputing device, either general-purpose or specifically constructed,used for processing; a computer display screen and/or printer and/orspeaker for displaying; machine-readable memory such as optical disks,CDROMs, magnetic-optical discs or other discs; RAMs, ROMs, EPROMs,EEPROMs, magnetic or optical or other cards, for storing, and keyboardor mouse for accepting. The term “process” as used above is intended toinclude any type of computation or manipulation or transformation ofdata represented as physical, e.g. electronic, phenomena which may occuror reside e.g. within registers and/or memories of a computer. The termprocessor includes a single processing unit or a plurality ofdistributed or remote such units.

The above devices may communicate via any conventional wired or wirelessdigital communication means, e.g. via a wired or cellular telephonenetwork or a computer network such as the Internet.

The apparatus of the present invention may include, according to certainembodiments of the invention, machine readable memory containing orotherwise storing a program of instructions which, when executed by themachine, implements some or all of the apparatus, methods, features andfunctionalities of the invention shown and described herein.Alternatively or in addition, the apparatus of the present invention mayinclude, according to certain embodiments of the invention, a program asabove which may be written in any conventional programming language, andoptionally a machine for executing the program such as but not limitedto a general purpose computer which may optionally be configured oractivated in accordance with the teachings of the present invention. Anyof the teachings incorporated herein may wherever suitable operate onsignals representative of physical objects or substances.

The embodiments referred to above, and other embodiments, are describedin detail in the next section.

Any trademark occurring in the text or drawings is the property of itsowner and occurs herein merely to explain or illustrate one example ofhow an embodiment of the invention may be implemented.

Unless specifically stated otherwise, as apparent from the followingdiscussions, it is appreciated that throughout the specificationdiscussions, utilizing terms such as, “processing”, “computing”,“estimating”, “selecting”, “ranking”, “grading”, “calculating”,“determining”, “generating”, “reassessing”, “classifying”, “generating”,“producing”, “stereo-matching”, “registering”, “detecting”,“associating”, “superimposing”, “obtaining” or the like, refer to theaction and/or processes of a computer or computing system, or processoror similar electronic computing device, that manipulate and/or transformdata represented as physical, such as electronic, quantities within thecomputing system's registers and/or memories, into other data similarlyrepresented as physical quantities within the computing system'smemories, registers or other such information storage, transmission ordisplay devices. The term “computer” should be broadly construed tocover any kind of electronic device with data processing capabilities,including, by way of non-limiting example, personal computers, servers,computing system, communication devices, processors (e.g. digital signalprocessor (DSP), microcontrollers, field programmable gate array (FPGA),application specific integrated circuit (ASIC), etc.) and otherelectronic computing devices.

The present invention may be described, merely for clarity, in terms ofterminology specific to particular programming languages, operatingsystems, browsers, system versions, individual products, and the like.It will be appreciated that this terminology is intended to conveygeneral principles of operation clearly and briefly, by way of example,and is not intended to limit the scope of the invention to anyparticular programming language, operating system, browser, systemversion, or individual product.

Elements separately listed herein need not be distinct components andalternatively may be the same structure.

Any suitable input device, such as but not limited to a sensor, may beused to generate or otherwise provide information received by theapparatus and methods shown and described herein. Any suitable outputdevice or display may be used to display or output information generatedby the apparatus and methods shown and described herein. Any suitableprocessor may be employed to compute or generate information asdescribed herein e.g. by providing one or more modules in the processorto perform functionalities described herein. Any suitable computerizeddata storage e.g. computer memory may be used to store informationreceived by or generated by the systems shown and described herein.Functionalities shown and described herein may be divided between aserver computer and a plurality of client computers. These or any othercomputerized components shown and described herein may communicatebetween themselves via a suitable computer network.

With regard to drawings and detailed descriptions of embodiments andexamples of the present invention, certain embodiments of the presentinvention are illustrated and described in detail in the incorporatedpatent publication of the priority patent document, namely, U.S. PatentApplication Publication No. 2012/0215560, to which reference is now madeas if such disclosure were set forth next herein.

It is appreciated that software components of the present inventionincluding programs and data may, if desired, be implemented in ROM (readonly memory) form including CD-ROMs, EPROMs and EEPROMs, or may bestored in any other suitable typically non-transitory computer-readablemedium such as but not limited to disks of various kinds, cards ofvarious kinds and RAMs. Components described herein as software may,alternatively, be implemented wholly or partly in hardware, if desired,using conventional techniques. Conversely, components described hereinas hardware may, alternatively, be implemented wholly or partly insoftware, if desired, using conventional techniques.

Included in the scope of the present invention, inter alia, arcelectromagnetic signals carrying computer-readable instructions forperforming any or all of the steps of any of the methods shown anddescribed herein, in any suitable order; machine-readable instructionsfor performing any or all of the steps of any of the methods shown anddescribed herein, in any suitable order; program storage devicesreadable by machine, tangibly embodying a program of instructionsexecutable by the machine to perform any or all of the steps of any ofthe methods shown and described herein, in any suitable order; acomputer program product comprising a computer useable medium havingcomputer readable program code, such as executable code, having embodiedtherein, and/or including computer readable program code for performing,any or all of the steps of any of the methods shown and describedherein, in any suitable order; any technical effects brought about byany or all of the steps of any of the methods shown and describedherein, when performed in any suitable order; any suitable apparatus ordevice or combination of such, programmed to perform, alone or incombination, any or all of the steps of any of the methods shown anddescribed herein, in any suitable order; electronic devices eachincluding a processor and a cooperating input device and/or outputdevice and operative to perform in software any steps shown anddescribed herein; information storage devices or physical records, suchas disks or hard drives, causing a computer or other device to beconfigured so as to carry out any or all of the steps of any of themethods shown and described herein, in any suitable order; a programpre-stored e.g. in memory or on an information network such as theInternet, before or after being downloaded, which embodies any or all ofthe steps of any of the methods shown and described herein, in anysuitable order, and the method of uploading or downloading such, and asystem including server's and/or client/s for using such; and hardwarewhich performs any or all of the steps of any of the methods shown anddescribed herein, in any suitable order, either alone or in conjunctionwith software. Any computer-readable or machine-readable media describedherein is intended to include non-transitory computer- ormachine-readable media.

Any computations or other forms of analysis described herein may beperformed by a suitable computerized method. Any step described hereinmay be computer-implemented. The invention shown and described hereinmay include (a) using a computerized method to identify a solution toany of the problems or for any of the objectives described herein, thesolution optionally include at least one of a decision, an action, aproduct, a service or any other information described herein thatimpacts, in a positive manner, a problem or objectives described herein;and (b) outputting the solution.

Features of the present invention which are described in the context ofseparate embodiments may also be provided in combination in a singleembodiment. Conversely, features of the invention, including methodsteps, which are described for brevity in the context of a singleembodiment or in a certain order may be provided separately or in anysuitable subcombination or in a different order. “e.g.” is used hereinin the sense of a specific example which is not intended to be limiting.Devices, apparatus or systems shown coupled in any of the drawings mayin fact be integrated into a single platform in certain embodiments ormay be coupled via any appropriate wired or wireless coupling such asbut not limited to optical fiber, Ethernet, Wireless LAN, HomePNA, powerline communication, cell phone, PDA, Blackberry GPRS, Satelliteincluding GPS, or other mobile delivery. It is appreciated that in thedescription and drawings shown and described herein, functionalitiesdescribed or illustrated as systems and sub-units thereof can also beprovided as methods and steps there within, and functionalitiesdescribed or illustrated as methods and steps there within can also beprovided as systems and sub-units thereof. The scale used to illustratevarious elements in the drawings is merely exemplary and/or appropriatefor clarity of presentation and is not intended to be limiting.

What is claimed is:
 1. A client computing device comprising: a processor; a display; and memory that has a client application stored therein, wherein the client application, when executed by the processor, causes the processor to perform acts comprising: receiving an indication of context, using a computerized context interception process, of a client electronic health record application (EHR) executing on the client computing device, the client EHR in communication with a server EHR executing on a first server computing device, wherein the indication of context comprises an identifier associated with a patient, wherein data pertaining to the patient is displayed in a graphical user interface (GUI) of the client EHR on the display; transmitting a query to a server application executing on a second server computing device that is in communication with the client computing device, wherein the query comprises the identifier associated with the patient, and further wherein the server application, responsive to receiving the query, causes a search to be performed over clinical data based upon the query to generate search results, the search results comprising data pertaining to the patient that is sourced from a source other than the server EHR; subsequent to transmitting the query to the server application, receiving the search results from the server application; and causing at least a portion of the search results to be displayed in a GUI of the client application.
 2. The client computing device of claim 1, wherein the search results exclude clinical data sourced from a server EHR executing on a second server computing device that is in communication with the client computing device.
 3. The client computing device of claim 1, wherein the portion of the search results displayed in the GUI of the client application comprises a link to clinical data maintained by the server application.
 4. The client computing device of claim 1, wherein the GUI of the client application further comprises an input field configured to receive user input, wherein responsive to receipt of user input comprising a keyword by way of the input field, the client application searches over the search results based upon the keyword for a portion of the search results that comprises the keyword.
 5. The client computing device of claim 4, wherein the GUI of the client application further comprises a results field configured to present the portion of the search results that comprises the keyword responsive to receipt of the user input comprising the keyword by way of the input field.
 6. The client computing device of claim 1, the acts further comprising: subsequent to receiving the search results from the server application, receiving user input by way of the GUI of the client application, wherein the user input comprises a keyword; responsive to receiving the user input, performing a keyword search over the search results for a portion of the search results that comprises the keyword; and displaying the portion of the search results that comprises the keyword in the GUI of the client application.
 7. The client computing device of claim 1, wherein the GUI of the client application and the GUI of the client EHR are displayed concurrently on the display.
 8. A method performed by a client computing device, wherein at least one processor of the client computing device executes a client application, the method comprising: receiving context data, using a computerized context interception process, relating to data being displayed on a graphical user interface (GUI), of a client electronic health record application (EHR) executing on the client computing device, wherein the context data comprises an identifier associated with a patient to whom the data being displayed on the GUI of the client EHR pertains; transmitting a query to a server application, wherein the query comprises the identifier associated with the patient, and further wherein the server application, responsive to receiving the query, performs a search over clinical data based upon the identifier to generate search results, the search results comprising clinical data pertaining to the patient with whom the identifier is associated, wherein the server application, based upon the query, excludes from the search results clinical data that is sourced from a server EHR in network communication with the client EHR; subsequent to transmitting the query to the server application, receiving the search results from the server application; and causing at least a portion of the search results to be displayed in a GUI of the client application.
 9. The method of claim 8, the method further comprising: subsequent to receiving the search results from the server application, receiving input at the client application, wherein the input comprises a keyword; responsive to receiving the input, performing a keyword search over the search results based upon the keyword to generate second search results, the second search results comprising the keyword; and displaying at least a portion of the second search results in the GUI of the client application.
 10. The method of claim 8, wherein the query further comprises an identifier of the server EHR with which the client EHR is associated, and wherein the server application excludes from the search results portions of the clinical data that are sourced from the server EHR based upon the identifier of the server EHR.
 11. The method of claim 8, the method further comprising: outputting at least a portion of the search results to a decision support application, the decision support application configured to perform a computerized analysis of the search results to determine a diagnosis relating to the patient.
 12. The method of claim 8, wherein the portion of the search results displayed in the GUI of the client application comprises a link to clinical data maintained by the server application.
 13. A non-transitory computer-readable storage medium comprising a server application that, when executed by a processor of a server computing device, causes the processor to perform acts comprising: receiving a query from a client application executing on a client computing device, the query based upon context data relating to data being displayed on a graphical user interface (GUI) of a client electronic health record application (EHR) executing on the client computing device, the context data being received using a computerized context interception process, and comprising an identifier of a patient to whom the data being displayed on the GUI of the client EHR pertains, wherein the query includes the identifier; transmitting a second query to a health-information exchange application (HIE), the second query configured to cause the HIE to execute a search over clinical data based upon the identifier in order to generate search results, the search results comprising a portion of the clinical data that pertains to the patient, the clinical data comprising data sourced from a source other than a server EHR in network communication with the client EHR; and responsive to receiving the search results from the HIE, transmitting the search results to the client application such that the client application causes the search results to be displayed in a GUI of the client application.
 14. The non-transitory computer-readable storage medium of claim 13, wherein the query and the second query each comprise an identifier of the server EHR, and wherein the HIE excludes from the search results data that is sourced from the server EHR based upon the identifier of the server EHR.
 15. The non-transitory computer-readable storage medium of claim 13, wherein the query is further indicative of a data type, and wherein the second query is configured to cause the HIE to execute the search over the clinical data based further upon the data type.
 16. The non-transitory computer-readable storage medium of claim 13, the acts further comprising: based on the search results, performing a computerized analysis of the search results to determine a diagnosis with respect to the patient; and outputting data indicative of the diagnosis to the client application for display at the client computing device. 